Discrimination and mental health of Somali immigrants in North America: a longitudinal study from 2013 to 2019.

PURPOSE: Immigrant mental health is closely linked to the context of reception in the receiving society, including discrimination; past research has examined this relationship only cross-sectionally. This longitudinal study examines the relationships between discrimination and mental health among Somali immigrants living in North America from 2013 to 2019. METHODS: Data for 395 participants (mean age 21 years at Time 1) were collected through the four-wave Somali Youth Longitudinal Study in four cities: Boston, MA, Minneapolis, MN, Lewiston/Portland, ME, and Toronto, ON. Latent linear and quadratic growth models were used to predict mental health symptoms over time and discrimination's role in these changes. RESULTS: PTSD and anxiety symptoms decreased from 2013 to 2015 and subsequently increased. Depression was static from 2013 to 2015, worsening thereafter. Increases in discrimination predicted increases in mental health symptomatology at all timepoints. CONCLUSION: This study provides support for discrimination's toxic impact on mental health and suggests that recent increases in discrimination may have contributed to worsening mental health among Somali immigrants living in North America.

Supporting Women and Children Returning from Violent Extremist Contexts: Proposing a 5R Framework to Inform Program and Policy Development.

Women and children returning from areas formerly controlled by the Islamic State typically have experienced high levels of trauma and indoctrination, further complicating politically fraught efforts at reintegration and resettlement. Consequently, countries around the world are grappling with how best to manage the return of these women and children. To help better understand which types of programming can contribute to the successful, non-violent reintegration of these individuals, we incorporated ideas from existing Repatriation and Rehabilitation (R&R) literature, field practitioners, R&R subject matter experts, and literature from adjacent fields (e.g., refugee resettlement, criminal justice, psychological resilience) into a recommended best practice approach to supporting returning women and children. We propose a shift from "R&R" programming to what we call the "5R" framework: Repatriation/ Resettlement, Reintegration, Rehabilitation, and Resilience. This shift provides conceptual clarity related to how different program elements target proximal goals (e.g., wellbeing and personal safety, belonging and opportunity, non-violence, and dignity), and how programming can shift from more centrally- and government-held services to informal and community-based supports.

Rehabilitation and Reintegration of Women and Children Returning from Violent Extremist Contexts: A Rapid Review to Inform Program and Policy Development.

This rapid review used a systematic approach to examine the available literature on rehabilitation and reintegration (R&R) programs for women and children returning from contexts of violent extremism, examining common assumptions, inputs, activities and outcomes across diverse settings. Fifty-one documents including peer reviewed articles and grey literature were included in the analysis. The most common program activities identified included mental health services, community level social programs, promoting school and vocational enrollment, regular health services, and parenting training & education, though there was a lack of consensus around core program components. The analysis points to the need for a robust set of inputs and resources to implement R&R programs including government officials, child welfare, mental health professionals, teachers, law enforcement, healthcare, community leaders, and extended family. The review also uncovered a number of gaps. This includes the need to create clear and analytically distinct definitions of rehabilitation and reintegration that are applicable and relevant to key stakeholders, delineating age-appropriate activities and outcomes for young children, youth, and adults, defining frameworks for service delivery and coordination of stakeholders, and placing R&R programs within existing domains of public safety and restorative justice.

In their own voices: Latinas' experiences with a randomized controlled trial.

We conducted exit interviews with a random sample of 39 predominantly Central American immigrant mothers who had completed a longitudinal randomized controlled trial to prevent perinatal depression. We found that rates and levels of perinatal depression in the intervention and control groups were lower than expected and did not differ between groups at 1 year postpartum. Therefore, we conducted extensive semistructured interviews to (a) understand why these high-risk women had such low rates of major depressive episodes and depressive symptoms, and (b) determine if the mechanisms responsible for reductions in depression differed between the intervention and usual care groups. We discovered that the intervention group learned specific mood-management skills from their participation in the intervention, and that the control group experienced their participation in the study as a "low-dose" intervention. Our experience highlights the importance of conducting qualitative studies to understand quantitative outcomes of intervention studies.

Leveraging community-based mental health services to reduce inequities for children and families living in United States who have experienced migration-related trauma.

OBJECTIVE: Trauma systems therapy for refugees (TST-R) is a trauma-focused, culturally responsive mental health prevention and intervention model designed to meet the needs of children and families who are fleeing their home countries and seeking humanitarian refuge. TST-R provides trauma-focused mental health treatment and addresses problems in part exacerbated by harsh U.S. immigration policies (e.g., poor mental health, stigma, fear) that have implications for the psychosocial well-being of immigrant children and families, especially those who have experienced migration-related trauma. METHOD: Informed by a community-based participatory research approach, TST-R was developed as an adaptation of trauma systems therapy to address common barriers to care experienced by those of refugee and immigrant backgrounds, including mental health stigma, distrust of service systems, and cultural and linguistic barriers. RESULTS: TST-R is a multitiered and phase-based intervention that strategically addresses stressors and needs across levels of the social ecology. Most TST-R services are delivered in easily accessible, nonstigmatizing settings (e.g., school) by a cultural broker and a clinician who work in partnership. TST-R has been disseminated and implemented with multiple cultural groups (e.g., Somali, Bhutanese) across the United States and Canada. CONCLUSIONS: Given the unique stressors, strengths, and needs of immigrant children and their families, mental health services must be equitable, community based, and sustainable. TST-R demonstrates promise as a prevention and intervention model especially for those experiencing immigration policy-related stressors and may serve as a guide for developing child mental health policies and immigration policies that promote mental well-being for immigrant families. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Discrimination, marginalization, belonging, and mental health among Somali immigrants in North America.

In this study, we examined the relationships among discrimination and mental health for Somali young adults, a group at risk for an unfavorable context of reception, and the way in which individual- and community-level factors explain these associations. The present study drew upon data collected during the first wave of the Somali Youth Longitudinal Study, a community-based participatory research project focused on understanding and supporting the healthy development of Somali young adults in four different regions in North America: Boston, MA, Minneapolis, MN, and Portland/Lewiston, ME in the United States and Toronto, Canada. Somali men and women aged 18-30 participated in quantitative interviews that included questions about their health, their neighborhoods, and their thoughts and feelings about their resettlement communities (N = 439). Results indicate that discrimination has a direct effect on worse mental health; this effect was mediated through both individual (marginalized acculturation style) and community-level (sense of belonging) factors. These findings suggest that factors associated with a receiving society's attitudes and behaviors, in addition to its structural supports and constraints, may be particularly important in understanding immigrant mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Rapid Review to Inform the Rehabilitation and Reintegration of Child Returnees from the Islamic State.

Background: An estimated 49,000 women and children who lived in the Islamic State are being held in the Al-Hol refugee camp in Syria. Several countries have repatriated some of these women and children, though most have thus far refused to do so. Many countries are asking whether it is possible to successfully rehabilitate and reintegrate this group and how the evidence base could inform their approach. Objective: The overall objective of this paper is to inform the rehabilitation and reintegration of child returnees from the Islamic State by rapidly reviewing the evidence on children exposed to trauma and adversity. Methods: A rapid review was conducted to identify pertinent evidence regarding outcomes, risk and protective factors, and interventions and to build a framework that could guide policies and practices. Prior work in the areas of refugee children, war-impacted children, child criminal gang members, child victims of maltreatment, and child victims of sex trafficking was reviewed. Evidence was collected and analyzed from 31 prior reviews and studies. Findings: The Rehabilitation and Reintegration Intervention Framework (RRIF) incorporates five levels (individual, family, educational, community, and societal) and identifies five primary goals: 1) promoting individual mental health and well-being; 2) promoting family support; 3) promoting educational success; 4) promoting community support; and 5) improving structural conditions and protecting public safety. Implementing this framework requires public-private partnership with extensive civil society involvement. Conclusions: Rehabilitation and reintegration programs should be based on the evidence of prior work with children exposed to trauma and adversity. RRIF defines a multi-level approach that encompasses promoting individual mental health and well-being, family support, educational success, community support, structural conditions, and public safety. Further multi-disciplinary research is needed to develop evidence in several identified areas concerning child health and developmental problems, family custody, faith and religiosity, and violent extremism assessment and prevention.

Uncontrolled experiments: Treatment of contamination OCD during a pandemic.

Patients suffering from obsessive-compulsive disorder are vulnerable to exacerbation of symptoms related to contamination and illness during the current pandemic. A cognitive-behavioral psychotherapy group for adolescent females with obsessive-compulsive disorder made effective adaptations to promote resilience to stressors and social isolation during the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Residential mobility, mental health, and community violence exposure among Somali refugees and immigrants in North America.

Refugees and immigrants resettled in high income countries often later experience a new phase of residential uncertainty in search of safe and secure housing. This study investigated the effect of past year housing stability on symptoms of posttraumatic stress disorder (PTSD) and exposure to neighborhood violence among a sample of 1st and 2nd generation Somali young adults (N = 198) living in urban areas in North America. In one year, 8.1% of the sample experienced a forced move and 20.7% of the sample moved voluntarily. Discrimination, neighborhood violence, economic insecurity, and interpersonal conflict precipitated forced moves. Forced moves were associated with worsening PTSD symptomology over one year, while voluntary moves were associated with improvements in symptoms. The current study provides evidence of the importance of safe, stable housing for the mental health of young adult immigrants.

Factor structure and concurrent validity of the Cognitive Fusion Questionnaire (CFQ) in a sample of Somali immigrants living in North America.

The process of resettlement in a new country and culture is commonly one of intense stress. Somali immigrants and refugees living in North America represent a large ethnocultural group navigating the complexities of forced displacement and resettlement. Despite the immense resilience exhibited by Somali communities in resettlement, the behavioral health needs of these communities require effective and culturally appropriate psychological assessment tools that can be used across service and research sectors. Given this need, we sought to examine the psychometric properties and concurrent validity of the Cognitive Fusion Questionnaire (CFQ), a transdiagnostic measure of cognitive fusion, in a sample of 233 (M age = 25.35; female = 45%) Somali young adults living in North America. Results using confirmatory factor analysis demonstrated that the one-factor structure of the CFQ previously found in other diverse populations held in the present sample. The structure and related item loadings were invariant across three key variables: gender, age, and location of resettlement in North America. Importantly, cognitive fusion was meaningfully associated with aspects of clinical and psychosocial functioning thought to be highly relevant to this population, including posttraumatic stress, anxiety, and depression symptoms, thwarted belongingness and perceived burdensomeness, and experiences of discrimination. Building upon the growing body of evidence supporting the CFQ's strong psychometric properties across cultural groups, researchers, and clinicians should have an added degree of confidence and enthusiasm in utilizing this measure to support immigrant and refugee communities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Understanding the needs of children returning from formerly ISIS-controlled territories through an emotional security theory lens: Implications for practice.

BACKGROUND: Children who spent time in territories formerly controlled by the Islamic State of Iraq and Syria (ISIS) and who are now being reintegrated into their countries of origin have experienced significant trauma and may present with adjustment or mental health problems. OBJECTIVE: In this paper we describe how Emotional Security Theory (EST; Davies & Cummings, 1994) and its more recent formulation, EST-reformulated (EST-R; Davies & Martin, 2013, 2014), provide a theoretical lens to aid in understanding the ways in which traumatic experiences under ISIS may have an enduring impact on a child's development and well-being. METHODS & RESULTS: The core assumption of EST is that maintaining safety and security is a central goal for a child growing up in the context of conflict. Children living in conflict zones under ISIS rule may have developed emotional insecurity, which in turn is theorized to lead to developmental cascades across multiple domains of functioning and at times result in clinically significant distress. This theoretical understanding can guide intervention, as it suggests that the foci of intervention must (1) minimize social signals indicative of threat while also (2) reducing behavioral response patterns that limit opportunities for exploration and prosocial affiliation. Trauma Systems Therapy is a multidisciplinary child trauma treatment model that addresses both stressors in the social environment and related emotional dysregulation. CONCLUSIONS: Challenges and considerations related to implementing such a comprehensive treatment approach in low- and middle-income countries are discussed.

Bhutanese Refugee Youth: The Importance of Assessing and Addressing Psychosocial Needs in a School Setting.

BACKGROUND: Traumatic exposure combined with significant stressors in resettlement place Bhutanese refugees at risk for mental health problems. Despite this, refugee youth often are reluctant to seek mental health services. Psychosocial support services, such as school-based groups, offer one solution to this barrier to care. We had 2 aims in this study: (1) to describe the psychosocial needs of resettled Bhutanese refugee students; and (2) to evaluate the impact of skills-based groups on these students' sense of school belonging and mental health. METHODS: Bhutanese refugee students in middle school (N = 34) participated in the 12-week group curriculum (a component of Trauma Systems Therapy for Refugees) and the associated preevaluation/postevaluation. RESULTS: Baseline descriptive analyses indicated high levels of mental health symptoms; approximately, 49% of students met partial or full criteria for posttraumatic stress disorder. In addition, sense of school belonging was significantly inversely associated with depressive and posttraumatic stress symptoms at baseline. Paired sample t tests indicate that students' avoidance symptoms significantly decreased postintervention. CONCLUSIONS: Findings suggest that skills-based groups may be an effective way to engage students in supportive services and address psychosocial needs. Results further highlight the potential protective role of school belonging in reducing refugee students' vulnerability to psychological distress.

Internalizing disorders in early childhood: a review of depressive and anxiety disorders.

This article reviews the use of the broad category of internalizing disorders and data on young children using this definition. It also reviews the emerging support for more specific internalizing diagnoses in very young children. The current empiric database on nosology and treatment of mood and anxiety disorders in young children is examined, and a clinical case example is included. Identification of recent advances in the understanding and treatment of anxiety disorders in young children and areas in which future studies are needed also are explored.